Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00360
41 4 0 01 (" DEVELOPMENT SERVICES DATE ISSUED: 6/17/2004
.,� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2S 112 BC- 02100
SITE ADDRESS: 14675 SW 84TH CT
SUBDIVISION: HAMBACH PARK ZONING: R -4.5
• BLOCK: LOT : 005 JURISDICTION: TIG
Project Description: (1.) branch circuit for new a /c.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: , PUMP /IRRIGATION:
EACH ADD'L 500SF: 1 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS - ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 = 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: • > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: .
Owner: Contractor:
NESBITT, DAN & JOAN OWNER
14675 SW 84TH CT
TIGARD, OR 97224
Phone: 503- 968 -1881 Phone:
Reg #:
F EES •
. Description Date Amount
• Required Inspections
[ELPRMT] ELC- Permit 6/17/2004 $46.85
[TAX] 8% State Surcharge 6/17/2004 $3.75 Rough -in
Elect'I Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is •
suspended for orp than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Or -•. n Utility Notif tion Center. Those
rules a t forth in 0' - 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rul _: or ••ire questi to OUNC at (503)
246 99 or 1-800-332-23
I
Iss ed By: k i, �� _ . / I, 4 d I Permit Signature: C ° we e .
•
O NER IN , LATION ONLY
•
The installation is being made on pro. -rty I • ich •t • - d for sale, lease, or rent.
OWNER'S SIGNATURE: ` � i' / " DATE: 6 %7.y
CO ' TRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
13125 SW Hall Blvd., Tigard, OR 97223 Plan / / / .� i
Plaan n R Re eview
Phone: 503.639.4171 Fax: 503.598.1960 � M +� Other Permit:
ilii Date/B :
Inspection Line: 503.639.4175 1 � e• W Date Ready/By: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: WA Supplemental Information
TYPE :OF WORK - - . -- PLAN REVIEW , ' REVIEW , ,
❑ •New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF - CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
j4 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION - ❑Egress/lighting plan RV park
Job no.: Job site address: �d.16 LID Z �T • DHealth-care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: --riGc,2A QM e — G I � 9 71.2:1- The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE ,:; : '
- Description Qty. I Fee. Total I -.
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no • Limited energy, non - res 75.00 2
DESCRIPTION OF WORK- Each manufactured or modular
dwelling, service and /or feeder 90.90 2
VO T ./JCf Li ��� I�~ Services or feeders installation, alteration, and/or relocation
— r -Tana. Al2 ceph.a>1- ^1 0•3 200 amps or less 80.30 2
• PROPERTY OWNER ❑ TENANT • 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: ��� NiEz. iv- - 601 amps to 1,000 amps 240.60 2
Address: 1477 .Lk.) gcrtvt c1-- Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: • aD ®IL_ �i77. ij. Temporary services or feeders installation, alteration, and/or
t relocation
Phone: ( 'PM l Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits— new, alteration, or extension, per panel
❑ APPLICANT r ❑ CONTACT PERSON A. Fee for branch circuits with
' service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit / 46.85 2
Address: Each add'l branch circuit 6.65 _ 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
,
'CONTRACTOR energy panel, alteration, or
l!/ , ` , extension. Describe: Page 2 2
Business name: V � /
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal L/t . 75
Suprv. Electrician signature, required: Plan review (25% of permit fee)
// State surcharge (8% of permit fee) 3 , 75
Print name: ' Date:
/
TOTAL PERMIT FEE , 0 • (Q0
Authorized signature: r/ This permit application expires if a permit is not obtained within 180
/ days after it has been accepted as complete
Print name: ,ade� / J, Date: / O/' e;157.
5 • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
1:\ Building \ Permits \ELC- PermitApp.doc 17/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2.- Supplemental Information
LIMITED ENERGY PERMIT FEES:
t� � .,
OSia*TAI. V !OR _:ON 7 77
Fee for all residential systems combined .. $75.00
Check Type of Work. Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System* •
❑ Vacuum Systems*
❑ Other:
V(): - e p RQAL ;P
Fee for each commercial system $75.00
(SEE OAR 918 -260 -260) •
Check Type of Work Involved:
❑ Audio and Stereo Systems _
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
•
❑ Fire Alarm Installation
❑ HVAC -
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control* -
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is\ Building \Pennits\ELC- PermitApp.doc 04/03